摘要:

Objective:To evaluate the prevalence of asymptomaticChlamydia trachomatisgenitourinary infection in women with human immunodeficiency virus (HIV) infection.Methods:The prevalence of asymptomatic chlamydial genitourinary infection in HIV‐seropositive women was compared with both HIV‐seronegative controls and women with unknown HIV status.Chlamydia trachomatiswas isolated in cell culture from endocervical and urethral specimens.Results:The prevalence of genitourinaryC trachomatisinfection among HIV‐seropositive women was 18.3% (21 of 115), a rate significantly higher than in both HIV‐negative women (11 of 136;P= .016) and controls with unknown HIV status (18 of 326;P= .0001). Crude odds ratios for endocervical and urethral chlamydial infection in HIV‐seropositive women compared to HIV‐seronegative controls were 2.6 (95% confidence interval [CI] 1.13‐6.08) and 3.3 (95% CI 1.15‐9.67), respectively. After adjustment for variables related to sexual habits, there was no difference in the risk of cervicalC trachomatisinfection between HIV‐seropositive cases and HIV‐seronegative controls (Mantel‐Haenszel odds ratio 1.04, 95% CI 0.93‐1.14;P= .41). Finally, in HIV‐seropositive patients, both the severity of immunosuppression evaluated by CD4+, CD8+, and total lymphocyte counts and the detection of p24 HIV‐related antigen did not correlate with the presence of chlamydial infection.Conclusions:Women infected with HIV are at high risk for asymptomatic genitourinary chlamydial colonization. To prevent a possible “epidemic” of pelvic inflammatory disease, appropriate screening programs and therapeutic strategies should be planned.(Obstet Gynecol 1994;83:1005‐10)

ISSN:0029-7844    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Objective:To explore the association between the use of the Cavitron Ultrasonic Surgical Aspirator for cytoreduction of ovarian cancer and the intraoperative development of disseminated intravascular coagulation (DIC).Methods:A retrospective chart review was performed of all patients undergoing surgery for ovarian cancer from September 1991 to February 1993. Data were extracted to correlate clinical and hematologic evidence of DIC with and without intraoperative use of the Cavitron Ultrasonic Surgical Aspirator. Statistical analyses were done byX2and analysis of variance.Results:Fifty‐one patients underwent surgery for ovarian cancer; 33 had stage IIIB, IIIC, IV, or recurrent disease and could be evaluated for this study. Nineteen patients were treated with the surgical aspirator, five of whom developed an intraoperative coagulopathy, as compared to none of 14 patients treated with conventional cytoreduction (P< .04,X2). The duration of use of the surgical aspirator correlated with the risk of coagulopathy (P< .001, analysis of variance).Conclusion:These data suggest a potential risk of developing DIC after extended use of the Cavitron Ultrasonic Surgical Aspirator for cytoreduction of ovarian cancer.(Obstet Gynecol 1994;83:1011‐4)

ISSN:0029-7844    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Objective:To determine whether tumors meeting the criteria of Hendrickson and Kempson for uterine smooth‐muscle tumors of uncertain malignant potential have a natural history different from those of leiomyomas and leiomyosarcomas.Methods:Tumors with five to ten mitoses per ten high‐power fields and with mild or moderate cellular atypia were classified as tumors of uncertain malignant potential. Tumors with two to four mitoses per ten high‐power fields and severe cellular atypia would also be classified as tumors of uncertain malignant potential, but we had no tumors that fell into this latter group. Forty‐seven women with leiomyosarcoma or smooth‐muscle tumors of uncertain malignant potential were identified. Paraffin‐embedded blocks were recut, and hematoxylin and eosin‐stained sections were studied for mitotic counts and cellular atypia. Statistical analysis usedX2, Fisher exact test, Studentttest, and Kaplan‐Meier life table analysis.Results:Fifteen tumors were classified as uncertain malignant potential and 32 as leiomyosarcomas. The patients with leiomyosarcoma were significantly older and more likely to present with extrauterine disease. Those with tumors of uncertain malignant potential had a 5‐year disease‐free survival of 66% and overall survival of 92%, compared to 28 and 40%, respectively, for leiomyosarcomas; these differences were statistically significant. Patients with tumors of uncertain malignant potential tended to have a protracted clinical course after development of recurrence, and several survived longer than 5 years with metastatic disease.Conclusions:Patients with five to ten mitoses per ten high‐power fields and mild to moderate cellular atypia had a prognosis significantly better than that of patients with leiomyosarcomas. In this group, only 27% developed a recurrence, and after recurrence they tended to have a protracted course. Some of these tumors do have a very aggressive course, and the term “uncertain malignant potential” is appropriate.(Obstet Gynecol 1994;83:1015‐20)

ISSN:0029-7844    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Objective:To assess the uterine hemodynamics in gestational trophoblastic tumors and to correlate them with response to chemotherapy.Methods:Using transvaginal color Doppler ultrasound, we measured the peak systolic velocity and the resistance index (RI) of the uterine arteries in 23 women with gestational trophoblastic tumors before each course of chemotherapy. Fifty‐five nonpregnant women and another 15 women who had uneventful molar evacuation were enrolled as controls. Two‐tailed Studentttest was used for statistical analysis.Results:A hyperdynamic uterine circulation was noticed at diagnosis in all gestational trophoblastic tumors, manifested as higher peak systolic velocity (mean ± standard deviation 57.5 ± 20.4 cm/second) of the uterine arteries compared to nonpregnant (28.3 ± 3.41 cm/second;P< .0001) and uneventful post‐mole uteri (26.8 ± 3.08 cm/second;P< .0001). The RI values of the uterine arteries in gestational trophoblastic tumors at diagnosis ranged from 0.21‐0.80. However, the mean value (0.56 ± 0.19) was lower than those of nonpregnant (0.80 ± 0.05;P< .0001) and post‐mole uteri (0.75 ± 0.06;P< .0001). A higher pre‐treatment uterine artery RI (mean 0.71 ± 0.09) was noted in ten patients with gestational trophoblastic tumors requiring fewer than five courses of chemotherapy, compared with the mean in 13 patients requiring longer courses of treatment (0.47 ± 0.14;P< .0001). There was a marked decrease of peak systolic velocity during the first three courses of treatment in the former group (54.2 to 23.6 cm/second;P< .001), in contrast to no change in the latter group (60.1 to 60.5 cm/second).Conclusion:Uterine hemodynamic characteristics assessed by color Doppler ultrasound might predict and monitor the response to chemotherapy in gestational trophoblastic tumors.(Obstet Gynecol 1994;83:1021‐5)

ISSN:0029-7844    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Objective:To compare acceptability, tolerance of side effects, and continuation rates among adolescent and adult Norplant accepters.Methods:An 18‐month observational study was conducted of 136 adolescents and 542 adults who received Norplant at the Francis Scott Key Medical Center in Baltimore, Maryland. Data were collected from the following: a self‐administered history form completed at the preinsertion visit, a self‐administered follow‐up form completed at routine follow‐up visits, problem‐visit chart review, and telephone contact for patients noncompliant with follow‐up appointments.Results:The adolescents ranged in age from 13‐18 years (mean 16.4), and adults ranged in age from 19‐46 (mean 24.7). The mean parity among teenagers was 1.4; among adults, 3.2. Thirty‐nine percent of teenagers and 64% of adults had had one or more therapeutic abortions. Forty percent of adolescents and 47% of adults reported at least one contraceptive failure in the past. Both adolescent and adult Norplant accepters made few telephone calls or problem visits because of complaints or side effects. Compliance with routine annual follow‐up was poor for adolescents (24 of 136, 18%) and adults (72 of 542, 13%). Follow‐up of noncompliant patients revealed low rates of implant removal. Fifteen adolescents (11%) and 60 adults (11%) had Norplant removed. The most common reasons for removal included irregular bleeding, weight gain, headaches, and desire for pregnancy.Conclusions:Implant acceptability, continuation, and tolerance of side effects were high and comparable among adolescent and adult accepters. Initial implant users were primarily adolescents or adults who had experienced problems with other forms of reversible contraception. Adherence to scheduled follow‐up appointments was poor, regardless of age.(Obstet Gynecol 1994;83:1026‐32)

ISSN:0029-7844    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Objective:To determine the prognostic value of a single serum progesterone measurement for resolution of ectopic pregnancy following methotrexate therapy.Methods:All patients attending our infertility clinic had quantitative &bgr;‐hCG and serum progesterone measured prospectively within the first week of missed menses. Ectopic pregnancy was diagnosed nonsurgically by poorly rising &bgr;‐hCG levels and lack of evidence of intrauterine gestation by transvaginal sonography. Once diagnosed, candidates received a single intramuscular injection of methotrexate, 50 mg/m2. Treatment outcome was categorized as either resolved or requiring surgery, and interpreted with respect to serum progesterone measured within 24 hours of methotrexate administration.Results:Twenty‐one patients were treated for ectopic pregnancy. Eleven had serum progesterone levels greater than 10 ng/mL and ten patients had levels of 10 ng/mL or less. The two groups did not differ significantly with respect to age, weight, hCG at the time of methotrexate administration, or amount of methotrexate administered. Of the 11 patients with serum progesterone levels above 10 ng/mL, only five had pregnancies that resolved following methotrexate. All ten patients with levels less than 10 ng/mL had resolution. This difference is significant (P= .009, 95% confidence interval 0.26‐0.84). There was no improvement in the prediction of outcome when either the absolute or daily percentage increase of hCG was determined before methotrexate administration.Conclusion:A single serum progesterone measurement above or below 10 ng/mL is useful for predicting resolution of tubal pregnancy with methotrexate treatment.(Obstet Gynecol 1994;83:1033‐7)

ISSN:0029-7844    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Objective:To investigate the accuracy and precision of a recent‐generation reflectance photometer, Accu‐Chek III, for gestational diabetes mellitus screening with a single operator.Methods:Four hundred ten paired capillary and serum glucose samples collected prospectively were evaluated by a reflectance photometer and a glucose oxidase method (Beckman), respectively, during routine gestational diabetes mellitus screening with a single operator.Results:The mean Accu‐Chek III result was 12% greater than serum glucose oxidase (115.5 ± 1.4 and 103.4 ± 1.3 mg/dL, respectively). A serum glucose level of at least 135 mg/dL by glucose oxidase produced sensitivity and specificity of 0.81 and 0.68, respectively. At 155 mg/dL, the Accu‐Chek III sensitivity was 0.81 and specificity 0.74, and the method produced fewer false‐positive results (37 of 410 [9.0%] versus 41 of 410 [10%] than a 135‐mg/dL serum cutoff. Adjusting the Accu‐Chek III threshold by two times the coefficient of variation resulted in the same number of false positives as the Beckman technique at 135 mg/dL. The receiver operating characteristic curve cutoff for the venous value of 135 mg/dL was an Accu‐Chek III value of 141 mg/dL. Linear regression analysis predictedy= 20.6 + 0.919x,r= 0.838. The mean coefficient of variation was 3.9%.Conclusions:The Accu‐Chek III produced accurate and precise gestational diabetes mellitus screening results with a single operator. Because capillary blood is a combination of arterial and venous blood, an Accu‐Chek III cutoff of 155 mg/dL may be more appropriate for screening, considering the 10‐15% higher capillary glucose level in the fed state. An Accu‐Chek III cutoff of 155 mg/dL produced a higher specificity than venous serum at 135 mg/dL, with no decrease in sensitivity.(Obstet Gynecol 1994;83:1038‐42)

ISSN:0029-7844    

出版商:OVID    

年代:1994

数据来源: OVID

ISSN:0029-7844    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Objective:To use meta‐analysis to evaluate the effect of epidural analgesia on the cesarean delivery rate.Data sources:The MEDLINE data base was searched for articles published in English between January 1981 and April 1992. We also interviewed experts and conducted a bibliographic follow‐up and manual review of recent journals published from April to July 1992.Methods of study selection:We excluded articles with irrelevant titles, and those case studies, book chapters, or articles that did not provide primary and relevant data. Two hundred thirty articles were read, including articles that reported on women of standard obstetric risk and on cesarean delivery rates for an epidural group and for a concurrent no‐epidural group. These criteria yielded six studies for a primary analysis and two others for a secondary analysis.Data extraction and synthesis:The sample size of the epidural and no‐epidural groups and the number of cesareans within each group were extracted. Tests of homogeneity were conducted. The pooled cesarean delivery risk difference as a result of epidural analgesia was estimated. The cesarean rate for women undergoing epidural analgesia was ten percentage points greater than for no‐epidural women (P< .05). More than a nine percentage point increase was shown for cesarean deliveries for dystocia (P< .05), when pooling either all studies or only randomized studies.Conclusions:The results of this meta‐analysis strongly support an increase in cesarean delivery associated with epidural analgesia. Further research should evaluate the balance between analgesia associated with the use of epidurals, and postpartum morbidity and costs associated with cesarean deliveries.(Obstet Gynecol 1994;83:1045‐52)

ISSN:0029-7844    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

&NA;The Peseshkef, a prehistoric flint knife in the shape of a fish tail, was used in Egypt to cut the umbilical cord at birth, circa 5000 BC. This was the first special‐purpose surgical instrument. Because of the importance of rebirth in the Egyptian religion, a stylized knife with magical properties became part of the equipment for the “opening of the mouth” ceremony to permit a mummy to partake of nourishment in the afterlife. It also became the emblem of the birth goddess, Meskhenet.(Obstet Gynecol 1994;83:1053‐5)

ISSN:0029-7844    

出版商:OVID    

年代:1994

数据来源: OVID